The use of rabies immune globulin by emergency physicians.

We sought to determine the incidence of practice patterns by emergency physicians that are non-compliant with present day World Health Organization recommendations regarding the administration of rabies immune globulin (RIG) in the prophylaxis of rabies. Of the 110 patients receiving RIG for rabies-prone wounds, 46 patients (41.8%; 95% CI 32-51.6%) were felt to have received the immunoglobulin in improper amounts at the bite site. In 43 of these 46 patients (92.8%; 95% CI 81.1-98.3%), there was a physician-written order on the chart directing the RIG be given in the older 50:50 method (one-half at the bite site, one-half elsewhere). Large numbers of patients still receive RIG inappropriately according to World Health Organization guidelines and more recently issued recommendations from the Advisory Committee on Immunization Practices. Treatment failures have been felt to occur secondary to inadequate RIG levels in wounds prophylaxed using the outdated recommendation. Emergency physicians need to be well versed and up to date with newer guidelines when prophylaxing patients for possible rabies exposure.